Accurately Diagnosing Rheumatoid Arthritis

Early diagnosis and immediate, aggressive treatment of rheumatoid arthritis are crucial because only a brief window of opportunity exists to prevent permanent disability and lifelong complications. However, early diagnosis is often difficult because the initial symptoms may mimic those of osteoarthritis, influenza (flu) and other viral illnesses. Further, the joints may not be red or swollen and may appear normal on X-rays.

Seven diagnostic criteria: part 1

Rheumatologists follow standardized guidelines for evaluating anyone who might have rheumatoid arthritis. No single laboratory test or diagnostic procedure can confirm the diagnosis. Instead, seven diagnostic criteria are used:

iStock

Seven diagnostic criteria: part 2

Morning stiffness

Arthritis in three or more joints

Arthritis in the hand joints

Symmetrical arthritis

Rheumatoid nodules

Elevated blood level of rheumatoid factor

Radiographic (X-ray) changes

Thinkstock

Next steps

The diagnosis will be rheumatoid arthritis if the first four criteria have been present for at least six weeks, long enough to rule out the possibility that a virus has caused the arthritis symptoms. Even if you don’t meet the four-of-seven criteria standard, you still may have rheumatoid arthritis. If you have two or three of the criteria, more testing is necessary because if you do have rheumatoid arthritis, even a short delay in beginning treatment can be harmful.

John A. Flynn, M.D., M.B.A., M.Ed., F.A.C.P., F.A.C.R., is a professor of medicine at the Johns Hopkins University School of Medicine. He is the associate dean and executive director of the Clinical Practice Association and vice president of the Office of Johns Hopkins Physicians. He is the medical director of the spondyloarthritis program and a founding member of the Johns Hopkins Primary Care Consortium.

Dr. Flynn received his doctor of medicine degree from the University of Missouri-Columbia and completed his internship and residency at the Johns Hopkins University School of Medicine, followed by a fellowship in rheumatology. Dr. Flynn also completed his master of business administration degree at the Johns Hopkins University and his master of education degree at the University of Cincinnati. He is board-certified in internal medicine and rheumatology and is a fellow with the American College of Rheumatology and the American College of Physicians. Dr. Flynn is the editor of the Oxford American Handbook of Clinical Medicine and Mosby’s Guide to Physical Examination.